PIP Fee - Help Center

Supported Formats

Input	Interpreted As
010125	January 1, 2025
01012025	January 1, 2025
1/1/25	January 1, 2025
01/01/25	January 1, 2025
1/1/2025	January 1, 2025
01/01/2025	January 1, 2025
1.1.25	January 1, 2025
01/01/25	January 1, 2025
1.1.2025	January 1, 2025
01.01.2025	January 1, 2025
1-1-25	January 1, 2025
01-01-25	January 1, 2025
1-1-2025	January 1, 2025
01-01-2025	January 1, 2025

Note: All formats must follow month/day/year.
year/month/day is not supported.
As shown, you may enter a date as a 6- or 8-digit number (no separators), using the MMDDYY or MMDDYYYY format. Leading zeros are required for single-digit months and days.

For example, entering 1125 will not work. Instead, try 010125.
Invalid Inputs

Input	Issue
1 1 25	Spaces not allowed
2025-01-01	Incorrect format (YYYY-MM-DD)
January 1, 2025	Month names not supported

Additional Notes
Two-digit years are treated as 20YY (e.g., 1/1/25 → 1/1/2025).
Dates are automatically reformatted to M/D/YYYY.
Future dates trigger an alert as they are not allowed.

How to Archive a Project
On the Open Project page, click Archive beside a project to remove it from the default Active Projects view.
Use the Show Projects dropdown to view active projects, archived projects, or all projects.
Archiving does not delete the project or its data.
How to Restore a Project
To return an archived project to the active list, select Archived Projects and click Restore.

Projects save automatically every five minutes. Upon the first save (whether automatically or manually), you will be redirected to the Edit Project page.
Learn more about each project’s fields ›

Some codes require modifiers to work. Learn more ›
Code Specifics
You must enter a code for every row.
Do not enter codes with spaces (e.g., G 0283).
If a code uses a space, use an alternate symbol such as a hyphen or underscore (e.g., G-0283 or G_0283) to retain clarity without breaking validation.
The system checks that the Code field is not empty.
PIP Fee also strips out spaces and triggers formatting alerts if characters are not allowed or if the code pattern doesn’t match fee schedule expectations.
Tip: Codes are not case-sensitive, but formatting matters.
Special Code Alerts
When you enter certain codes that fall under specific Medicare fee schedules, the system will alert you with additional guidance via an automatic pop-up. These alerts help ensure that required supporting fields (like Units) are entered correctly based on the code type.
Ambulance Fee Schedule Code
If you enter a code covered under the Ambulance Fee Schedule, you’ll see a pop-up titled Ambulance Fee Schedule Code Entered.
Per MCL 500.3157(13), the statutory fee schedule limitations do not apply to emergency medical services rendered by an ambulance operation.
The calculation will instead fall back to the standard adjustment of the provider's net charge (or the 2019 CDM, if applicable) as required for non-Medicare services.
Anesthesia Fee Schedule Code
When you enter a code recognized under the Anesthesia Fee Schedule, you’ll see a pop-up titled Anesthesia Fee Schedule Code Entered.
You will be prompted to enter the number of minutes anesthesia was administered in the Units field.
The system automatically converts these minutes into fifteen-minute increments for pricing purposes.
Learn more about the Anesthesia Fee Schedule ›
Medicare Part B Drug Code
If you enter a Medicare Part B drug code, you’ll see a pop-up titled Medicare Part B Drug Code Entered.
This alert provides important drug-specific billing information.
Depending on the drug, you may be required to use specific modifiers or units (e.g., per milligram or per vial).
The full message varies depending on the drug code entered.
Learn more about Medicare Part B drug codes ›

Click Import Medical Bill in the navigation menu under Projects.
Select the PDF containing the billing information you want to import.
Click Upload and Continue.
PIP Fee will analyze the PDF and automatically identify the individual billable or service lines contained in the document.
Review the extracted information, match each imported provider to the appropriate PIP Fee provider, and choose whether to add the rows to a New Project or an Existing Project.

Reviewing Imported Information
PIP Fee identifies the provider or organization associated with each imported service line when that information can be determined from the PDF.
For each imported provider, select the corresponding provider from the dropdown.
If a provider cannot be identified from the PDF, you may still manually select the appropriate PIP Fee provider.
When multiple providers are identified, they are displayed according to the order in which they first appear in the PDF.
Imported service lines are kept in the same order in which they appear in the PDF.
Depending on the information contained in the source document, PIP Fee may identify the Date of Service, Code, Modifiers, Units, Gross Charge, Adjustment, CDM Price, and Insurer Paid.
If a Code or Date of Service cannot be identified, or a Date of Service cannot be interpreted, a Review Note will appear for that row.
If Units are not identified, the imported row will default to 1 unit.
Adding the Imported Rows
Select New Project to place the imported rows into a new project.
Select Existing Project to add the imported rows to the end of an existing project's Data Entry rows.
Imported rows are not automatically saved. You can review, edit, complete, or remove them before using the project's normal save process.
For Best Results
Upload one medical bill or ledger for one provider at a time whenever possible.
PDFs containing multiple providers or separate ledgers may still be processed, but the extracted information may be less reliable.
Medical bill import supports PDF files only, with a maximum file size of 20 MB.
The uploaded PDF itself is not saved as part of the project.
AI Import Usage Limits
Each user may process up to 1,000 PDF pages per calendar month using Import Medical Bill.
Usage is measured by calendar month using UTC. Unused pages do not roll over to the next month.
Your personal AI import allowance does not increase if you subscribe to more than one state.
Organizations also have a shared monthly allowance equal to 1,000 pages for each active organization user. For example, an organization with 3 active users has a shared organization allowance of 3,000 pages per calendar month.
Each upload must fit within both the uploading user's remaining personal allowance and the organization's remaining shared allowance.
Your personal usage is displayed on the Import Medical Bill page. Organization administrators also see the organization's total AI import usage.
If either the personal or organization limit is reached, additional AI imports that would exceed the available allowance are blocked.
Pages count toward usage when the PDF is successfully processed by the AI service, even if no billable service lines are ultimately identified. If AI processing fails, those pages are not counted.
Important
Medical bill import is designed to reduce manual data entry. As errors can occur, always compare the imported information with the original medical bill before saving the project and correct or complete any information as needed.
Medical bill import extracts billing information from the source document. It does not calculate Medicare amounts, fee schedule prices, PIP reimbursement, statutory reductions, allowed amounts, or other reimbursement results. For calculating fee schedules, run a report.

Method 1
Click Open Project in the navigation menu.
View your list of projects, then
click Open next to the relevant project.

Method 2
Click Manage Providers in the navigation menu.
Using the Select an Existing Provider list,
click on a provider.
The resulting Manage Providers page shows all Projects Using this Provider.
Click Open next to the relevant project.

How to Move a Single Row
On the right side of each row, you will find Up and Down arrow icons.
Click the Up arrow to move a row higher in the list, or click the Down arrow to move it lower.
The row will slide smoothly into its new position, and the project will be marked as having unsaved changes.
How to Sort Multiple Rows
At the top right of the Data Entry section, locate the Sort By menus.
Select your primary criteria from the 1st Sort dropdown.
Once you make your first selection, the 2nd Sort dropdown will unlock. Selecting a second option unlocks the 3rd Sort, allowing you to organize your data on up to three specific levels.
Click the Sort button. Your rows will briefly highlight to confirm they have been reordered, and the project will be marked as having unsaved changes.

Some codes require modifiers to work. Learn more ›
When to Use Modifiers
If your service or item includes one modifier, enter it in the first modifier field.
If there are two modifiers, enter the second one in the second modifier field.
Do not enter more than two modifiers.
Leave modifier fields blank if no modifiers apply to the code you entered.
Accepted Modifier Codes
To be priced using the Medicare fee schedule, modifiers must match the codes PIP Fee recognizes for Medicare pricing.
Allowed in the First Modifier Field
26, 53, AU, AV, AW, KF, KM, KN, MS, NU, QW, RR, TC, UE
Allowed in the Second Modifier Field
BA, KC, KE, KF, KU, QB, QF
What Happens If You Use a Non-Medicare Modifier?
You can enter a modifier outside these lists (such as custom modifiers from providers), but the row will:
Bypass Medicare fee schedule logic; and
Be flagged with a warning.
These rows are not disqualified but will be processed as without a fee schedule match in your reports.
Best Practices
Modifiers must be entered exactly.
Use only one modifier per field.
Be cautious: Applying an unrecognized modifier will result in the code being processed as without a fee schedule match in your reports.
If you’re unsure whether a modifier is appropriate or eligible, consult CMS guidance.

General Usage
Optional: leave blank if no reduction applies.
Enter dollars and cents only (e.g., 75.00).
No currency symbols, commas, negatives, or percentages (they are automatically removed).
Do not exceed the Gross Charge; doing so will produce a negative Net Charge.
What it Does—and Doesn’t—Do
Does reduce the Net Charge shown on the report.
Does not change fee schedule pricing. Fee schedules are determined by code, modifiers, date of service, and units—not by adjustments.
Does not replace the Insurer Paid field. Enter insurer payments separately so the report can compute the Balance correctly.
Learn more about using the Insurer Paid field ›
Examples
Contracted write-off: enter 125.00
Courtesy discount: enter 25.00
No adjustment: leave blank or enter 0.00

Project Details
At the top, you’ll see fields for the Project Name and File Number. These are for your own reference but are required. Each is limited to 30 characters.
Data Entry Rows
Rows represent individual services. Fill in the required fields, including Provider, Date of Service, Code, and Units. Additional fields are available for code modifiers, gross charge, adjustments, CDM price (for Michigan subscriptions), and insurer-paid amounts.

Selecting a provider ›
Accepted date formats ›
Some codes require modifiers to work. Learn more ›
Real-Time Alerts and Validation
The system will flag issues as you type. For example, you’ll get alerts if you enter a future date, a non-Medicare modifier, or leave a required field blank.
Row Management
Use the plus (+) icon (or Tab) to add a row, the minus (−) icon to remove a row, and the copy icon to duplicate a row.

Use the checkboxes to select and delete multiple rows at once.

Rows can be reordered using the up/down arrows on the right or sorted using the controls at the top.
Saving Changes
Use the Save button at either the top or bottom of the page. If you try to navigate away without saving, you’ll be prompted to confirm.

The system also auto-saves every five minutes.
Running Reports
Once you’ve finished entering data, click Run Report. Make sure to save your changes first, or you’ll see an alert.

General Usage
Enter the billed amount exactly as it appears on the provider’s invoice or claim form.
Enter dollars and cents only (e.g., 75.00).
No currency symbols, commas, negatives, or percentages (they are automatically removed).
Purpose
The Gross Charge serves as the baseline for calculating any applicable fee schedule adjustments. It reflects the provider’s standard charge, not necessarily the reimbursable amount.

How It Works
The system calculates the allowed amount based on the Fee Schedule (including any applicable adjustments or multipliers).
It then subtracts the amount you enter in Insurer Paid from that Fee Schedule amount.
The result is shown in the Balance column of the Fee Schedule Pricing Report.
Formula
Fee Schedule − Insurer Paid = Balance

General Usage
This field is required.
Enter a whole number only—no decimals or fractions are accepted.
Ambulance Fee Schedule Code
If you enter a code covered under the Ambulance Fee Schedule, you’ll see a pop-up titled Ambulance Fee Schedule Code Entered.
Per MCL 500.3157(13), the statutory fee schedule limitations do not apply to emergency medical services rendered by an ambulance operation.
The calculation will instead fall back to the standard adjustment of the provider's net charge (or the 2019 CDM, if applicable) as required for non-Medicare services.
Anesthesia Fee Schedule Code
When you enter a code recognized under the Anesthesia Fee Schedule, you’ll see a pop-up titled Anesthesia Fee Schedule Code Entered.
You will be prompted to enter the number of minutes anesthesia was administered in the Units field.
The system automatically converts these minutes into fifteen-minute increments for pricing purposes.
Learn more about the Anesthesia Fee Schedule ›
Medicare Part B Drug Code
If you enter a Medicare Part B drug code, you’ll see a pop-up titled Medicare Part B Drug Code Entered.
This alert provides important drug-specific billing information.
Depending on the drug, you may be required to use specific modifiers or units (e.g., per milligram or per vial).
The full message varies depending on the drug code entered.
Learn more about Medicare Part B drug codes ›

Help Center

Projects

Accepted Date Formats The Date of Service (DOS) field accepts a variety of standard month/day/year formats. The system automatically converts valid entries to M/D/YYYY after you exit the field.

Supported Formats

Invalid Inputs

Additional Notes

Archiving Projects Hide completed or inactive projects without permanently deleting them.

How to Archive a Project

How to Restore a Project

Create a New Project Using the New Project page is quick and straightforward. Whether you’re starting a fresh case, analysis, or pricing review, it’s the essential page for developing the Fee Schedule Pricing Report.

Entering a Code Each data entry row includes a Code field, which is required and must be entered using valid formatting rules. This field typically contains CPT, HCPCS, or revenue codes used for fee schedule pricing.

Code Specifics

Special Code Alerts

Ambulance Fee Schedule Code

Anesthesia Fee Schedule Code

Medicare Part B Drug Code

Import a Medical Bill Save time entering medical bills by uploading a PDF and allowing PIP Fee to automatically identify billing information for review and import into a new or existing project.

Reviewing Imported Information

Adding the Imported Rows

For Best Results

AI Import Usage Limits

Important

Open a Previous Project Need to reopen a previous project? It’s easy to pick up right where you left off by following the steps below to locate and open any of your past projects in just a few clicks.

Method 1

Method 2

Reordering and Sorting Project Rows Easily move individual rows or apply multi-level sorting to organize your data.

How to Move a Single Row

How to Sort Multiple Rows

Using Modifiers Modifiers, when used, provide additional context to a billing code—such as how a service was delivered, whether equipment was rented or purchased, or whether professional or technical components were involved.

When to Use Modifiers

Accepted Modifier Codes

Allowed in the First Modifier Field

Allowed in the Second Modifier Field

What Happens If You Use a Non-Medicare Modifier?

Best Practices

Using the Adjustment Field The Adjustment field records any reductions to the provider’s Gross Charge (e.g., contractual write-offs, courtesy discounts, prior credits). The system calculates Net Charge = Gross Charge − Adjustment automatically.

General Usage

What it Does—and Doesn’t—Do

Examples

Using the Edit Project Page The Edit Project page is where you’ll do nearly all of your hands-on data entry. Each project consists of rows of billing data, including provider name, date of service, procedure code, modifiers, charges, and insurance payments.

Project Details

Data Entry Rows

Real-Time Alerts and Validation

Row Management

Saving Changes

Running Reports

Using the Gross Charge Field The Gross Charge field is used to record the total amount the provider billed for the service, supply, or drug before any adjustments, discounts, or the like.

General Usage

Purpose

Using the Insurer Paid Field Use the Insurer Paid field to enter the amount the insurer has already paid toward the billed service or supply. This value is used to reduce the calculated Fee Schedule amount, allowing the system to determine the Balance still owed.

How It Works

Formula

Using the Units Field The Units field allows you to specify the quantity associated with the code you’ve entered. This value may represent services rendered, minutes, or mileage, depending on the fee schedule tied to the code.

General Usage

Ambulance Fee Schedule Code

Anesthesia Fee Schedule Code

Medicare Part B Drug Code